The emergency department serves as the front-line of medical care. This is especially true among the indigent population who often use the emergency department as a source of primary care. Many visits to the emergency department, however, may be avoidable with patient and health provider education and other interventions. The emergency department is the missing piece of the prevention puzzle; the emergency department is where prevention begins, ranging from injuries to asthma. Preventing asthma morbidity is a U.S. Health Objective for the Year 2000. We propose to develop a problem, case-based curriculum on secondary preventive asthma education with an emphasis on avoiding emergency department visits. The curriculum will be multifaceted and will be applicable to many levels of health care providers: medical students, physicians (housestaff and rural community physicians), emergency nurses, pharmacists, and especially prehospital providers (emergency medical technicians-EMTs). Dissemination will be through many existing, innovative avenues that have been developed for rural statewide information transfer by our Medical School and Emergency Medical Services Academy. Two programs, Child Alert 10-33 and ChUMS, developed to provide the initial health care provider with medical information on chronically ill children will also be piloted using asthmatic children as a targeted population. Through involvement in these programs rural pre-hospital provider (EMT) participation in primary care will be enhanced. Evaluation of the curriculum will be through pre and post-testing of the participants on objectives of the curriculum. Medicaid prescribing trends will also be monitored as an estimate of impact by the curriculum. The Child Alert 10-33 and ChUMS programs in the rural areas will be evaluated through follow-up survey of providers and parents regarding the effectiveness of the programs.